RANDY W JOHNSON (NPI# 1659932580) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659932580 |
| Entity Type | Individual |
| Full Name | RANDY W JOHNSON |
| Credential | NP |
| Practice Address |
736 Broadway N Fargo ND 58102-4421 |
| Mailing Address |
4417 12th St W West Fargo ND 58078-8829 |
| Practice Telephone | 7012000718 |
| Mailing Telephone | 7012000718 |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2019-10-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | R32408 | ND | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LA2100X |
Nurse Practitioner Specialization: Acute Care |
R32408 | ND | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053958736 | Randy Johnson | Technician | 3221 Gina Drive, Memphis, TN 38118 | 2019-12-02 |
| 1497041065 | Randy Lee Johnson | Contractor | 824 9th St N, Sartell, MN 56377-2248 | 2011-06-22 |
| 1871716225 | Randy Johnson | Dentist | 3053 Freedom Dr, Charlotte, NC 28208-3859 | 2007-04-11 |
| 1124180450 | Randy Robert Johnson | Chiropractor | 1706 East Tenth Street, Gauer Chiropractic Clinic, Glencoe, MN 55336 | 2006-12-14 |
| 1295843795 | Randy Roy Johnson | Chiropractor | 10600 South Ave, Chisago City, MN 55013-9577 | 2006-08-26 |
| 1417970971 | Randy Johnson | Specialist/Technologist | 5150 Farna Ave, Arcadia, CA 91006-5966 | 2006-07-25 |
| 1972581957 | Randy Gordon Johnson | Pharmacist | 34617 Se 56th Pl, Fall City, WA 98024-8806 | 2006-01-09 |
| 1073787677 | Randy M Johnson | Physician Assistant | 2200 Whitney Avenue, Suite 360, Hamden, CT 06518-3694 | 2008-04-15 |
| 1629247317 | Randy Johnson | Prosthetic/Orthotic Supplier | 405 Parkway, Suite G, Greensboro, NC 27401-1308 | 2008-02-27 |
| 1508035189 | Randy Lee Johnson | Durable Medical Equipment & Medical Supplies | 117 E Main St, Dundee, FL 33838-4219 | 2008-02-27 |
| Street Address |
736 BROADWAY N |
| City | FARGO |
| State | ND |
| Zip Code | 58102-4421 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700856911 | Douglas M Griffin | Family Medicine | 736 Broadway N, Fargo, ND 58102-4421 | 2006-01-23 |
| 1528666914 | Brett Brockpahler | Physical Therapist | 736 Broadway N, Fargo, ND 58102-4421 | 2020-10-16 |
| 1235756040 | Ramneet Kaur Singh | Family Medicine | 736 Broadway N, Fargo, ND 58102-4421 | 2020-06-26 |
| 1467002733 | Cassandra Nicole Flach | Physical Therapist | 736 Broadway N, Fargo, ND 58102-4421 | 2019-09-18 |
| 1710548862 | Jeremiah Johnson | Nurse Practitioner | 736 Broadway N, Fargo, ND 58102-4421 | 2019-06-27 |
| 1427618800 | Alison Lynn Kopp | Physical Therapist | 736 Broadway N, Fargo, ND 58102-4421 | 2019-06-18 |
| 1952867178 | Heather Crystal Carkhuff | Physician Assistant | 736 Broadway N, Fargo, ND 58102-4421 | 2019-02-12 |
| 1790256329 | Danielle Jo Matta | Nurse Practitioner | 736 Broadway N, Fargo, ND 58102-4421 | 2018-12-07 |
| 1013483692 | Tamera Ostenaa | Family Medicine | 736 Broadway N, Fargo, ND 58122-4732 | 2018-10-22 |
| 1952877862 | Kari Ann Solberg | Family Medicine | 736 Broadway N, Fargo, ND 58102 | 2018-10-17 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780285924 | Shelley Dene Townsend-hansen | Dentist | 1017 Broadway N, Fargo, ND 58102 | 2020-11-04 |
| 1275190779 | Anthony Joseph Duncan | Student in an Organized Health Care Education/Training Program | 1919 Elm Streent North, Fargo, ND 58102 | 2019-05-21 |
| 1003472317 | Sadie Marie Nelson | Nurse Practitioner | Sanford Broadway Clinic, 801 North Broadway, Fargo, ND 58102 | 2019-05-13 |
| 1124523576 | Christopher Peroutka | Specialist/Technologist | 1300 17th Ave N, Fargo, ND 58102 | 2018-03-28 |
| 1205331873 | Nathan Koens | Specialist/Technologist | 1300 17th Avenue North, Fargo, ND 58102 | 2018-03-27 |
| 1376063370 | Abby Nicole Fredrickson | Student in an Organized Health Care Education/Training Program | 1919 Elm Street North, Fargo, ND 58102 | 2017-06-21 |
| 1780118331 | Stephanie Melquist | Internal Medicine | Internal Medicine Resident Clinic, 801 N Broadway, Fargo, ND 58102 | 2017-04-19 |
| 1104215623 | Justin Lervik | Social Worker | 211 Elm St. N, 122, Fargo, ND 58102 | 2015-01-21 |
| 1770919441 | Courtney Ann Simanski | Speech-Language Pathologist | 415 4th St. N., Fargo, ND 58102 | 2013-09-25 |
| 1821431206 | Lanell Staroba | Pharmacist | 706 D 38th St, Fargo, ND 58102 | 2013-04-16 |
| Find all providers in zip 58102 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003472317 | Sadie Marie Nelson | Nurse Practitioner | Sanford Broadway Clinic, 801 North Broadway, Fargo, ND 58102 | 2019-05-13 |
| 1245772359 | Andrea Marie Hanson | Nurse Practitioner | 2400 32nd Ave South, Fargo, ND 58103 | 2016-11-07 |
| 1437565330 | Christina Dahl | Nurse Practitioner | 1665 43rd St S Ste 102, Fargo, ND 58103-3316 | 2014-07-11 |
| 1003242256 | Wendy M Moore | Nurse Practitioner | 901 28th St S, Fargo, ND 58103 | 2013-09-19 |
| 1043599277 | Rebecca Ann Kiecker | Nurse Practitioner | 1720 South University Drive, Sanford South University, Fargo, ND 58103 | 2011-08-05 |
| 1780832634 | Sarah M Baker | Nurse Practitioner | 3274 51st St S, Fargo, ND 58104 | 2008-09-04 |
| 1932207149 | Carlee N Leininger | Nurse Practitioner | 2301 25th St S Ste A, Fargo, ND 58103-6104 | 2006-09-20 |
| 1780607788 | Casey M Hoover | Nurse Practitioner | Rejuv Medical Aesthetic Clinic, 3301 45th St S, Fargo, ND 58103 | 2006-07-25 |
| 1023030517 | Tina M Lundeen | Nurse Practitioner | 600 4th St S, Fargo, ND 58103-2804 | 2006-07-24 |
| 1992727481 | Melissa R Erdmann | Nurse Practitioner | 827 28th St S, Unit B, Fargo, ND 58103-8727 | 2006-07-24 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.